Combination of free‐breathing and breathhold steady‐state free precession magnetic resonance angiography for detection of coronary artery stenoses

Dewey, Marc; Teige, Florian; Schnapauff, Dirk; Laule, Michael; Borges, Adrian C.; Rutsch, Wolfgang; Hamm, Bernd; Taupitz, Matthias

doi:10.1002/jmri.20568

Cited by 32 publications

(13 citation statements)

References 43 publications

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“…The mean length of each coronary artery visualised in our study was longer than previously reported for 4-slice MSCT scanners [21] and electron beam CT [21,22] or magnetic resonance angiography [23][24][25][26][27]. The measured overall length of the coronary arteries was comparable to the results of previously published studies using 16-slice [15,20] and 64-slice scanners [28] (Table 3).…”

Section: Comparison With Other Studiessupporting

confidence: 86%

Comparison between the image quality of multisegment and halfscan reconstructions of non-invasive CT coronary angiography

Schnapauff

Teige²,

Hamm³

et al. 2009

BJR

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ABSTRACT. The purpose of this study was to compare the image quality of multisegment and halfscan reconstructions of multislice computed tomography (MSCT) coronary angiography. 126 patients with suspected coronary artery disease and uninfluenced heart rates were examined by 16-slice CT before they underwent invasive coronary angiography. Multisegment and halfscan reconstructions were performed in all patients, and subjective image quality, overall vessel length, vessel length free of motion artefacts and contrast-to-noise ratios (CNRs) were compared for both techniques. The diagnostic accuracy of both approaches was compared with the results of invasive coronary angiography. Overall image quality scores of multisegment reconstruction were superior to those of halfscan reconstruction (13.3¡2.1 vs 11.9¡2.9; p,0.001). Multisegment reconstruction depicted significantly longer overall coronary vessel lengths (p,0.001) and larger vessel proportions free of motion artefacts in three of the four main coronary arteries. CNRs in the left main, left anterior descending and left circumflex coronary arteries were significantly higher when multisegment reconstruction was used (p,0.001). Overall accuracy was higher for multisegment reconstruction compared with halfscan reconstruction (87% vs 62%). In conclusion, multisegment reconstruction significantly improves image quality and diagnostic accuracy of MSCT coronary angiography compared with standard halfscan reconstruction, resulting in vessel lengths depicted free of motion comparable to those of CT performed in patients given b-blockers to lower heart rates. Non-invasive coronary angiography is an alternative approach to conventional coronary angiography in patients with suspected coronary artery disease (CAD) with high clinical [1-4] and economic [5] relevance. Recently, multislice computed tomography (MSCT) has developed into the most reliable non-invasive method for imaging of the whole coronary artery tree [6]. The susceptibility of MSCT to motion artefacts can only be overcome by systematic prescan b-blockade to lower heart rates to target values below 65 beats per minute (bpm). Recent studies have shown that b-blocker administration is necessary even on 64-slice scanners [4,[7][8][9][10][11]. Motion artefacts result from a relatively long acquisition window, which is determined by the gantry rotation time in standard halfscan reconstruction. In contrast, multisegment reconstruction [12] reduces the acquisition time by using up to four different segments from up to four consecutive heart beats [13]. In this way, an acquisition window as short as one-eighth of the gantry rotation time can be achieved [14]. In a small retrospective study of 34 patients with suspected CAD, multisegment reconstruction showed superior image quality and diagnostic accuracy compared with halfscan reconstruction. Based on these results, it was suggested that there is no need for b-blocker administration when multisegment reconstruction is used [15]. However, a recently published subgroup analy...

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Section: Comparison With Other Studiessupporting

confidence: 86%

Comparison between the image quality of multisegment and halfscan reconstructions of non-invasive CT coronary angiography

Schnapauff

Teige²,

Hamm³

et al. 2009

BJR

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“…At present, coronary MRA with steadystate free precession (SSFP) is regarded as an increasingly advantageous approach to coronary MRA with its relatively high signal-tonoise ratio and good ability to image the coronary arteries [2,12,13]. To our knowledge, there have been no studies assessing the diagnostic capability of coronary MRA with SSFP for the detection of coronary stenosis in patients with high calcium scores.…”

Section: Conclusion-coronarymentioning

confidence: 99%

Comparison of 3D Free-Breathing Coronary MR Angiography and 64-MDCT Angiography for Detection of Coronary Stenosis in Patients with High Calcium Scores

Liu

Zhao

Huang

et al. 2007

American Journal of Roentgenology

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OBJECTIVE-The objective of our study was to compare the diagnostic performance of coronary MR angiography (MRA) and 64-MDCT angiography (MDCTA) for the detection of significant stenosis (≥ 50%) in patients with high calcium scores. MATERIALS AND METHODS-Eighteenpatients (12 men, six women; mean age, 56 y; age range, 38-77 y) who had at least one calcified plaque with a calcium score of > 100 underwent coronary MRA and conventional coronary angiography (CAG) within 2 weeks of MDCTA. Coronary MRA image quality of the calcified segments was assessed by two observers in consensus on a 4-point scale (1 = not visible, 2 = poor, 3 = good, 4 = excellent) using a 10-segment model from the modified American Heart Association classification. Three experienced radiologists, unaware of the results of conventional CAG, independently assessed for the presence of significant stenosis on MDCTA images and the corresponding MRA images. Receiver operating characteristic (ROC) curves were calculated for each reader using conventional CAG as the gold standard.RESULTS-Thirty-three calcified plaques with a calcium score of > 100 were detected on MDCTA in the 18 patients. The coronary segments with nodal calcification (n = 17) showed a higher mean image quality score than the segments with diffuse calcification (n = 16) (3.47 ± 0.62 vs 2.94 ± 0.77, respectively; p < 0.05). Of the 33 coronary segments with calcification, 12 significant stenoses were identified on conventional CAG. The sensitivity, specificity, and area under the ROC curve (AUC) for MRA and MDCTA, respectively, were as follows: reader 1, 75%, 81%, 0.82 versus 75%, 48%, 0.68; reader 2, 83%, 71%, 0.82 versus 67%, 52%, 0.63; and reader 3, © American Roentgen Ray Society Address correspondence to J. C. Carr.. Thirty-two eligible patients were recruited for the coronary MRA section of the study within 1-3 days after MDCTA examination. Twenty-seven patients (19 men and eight women; mean age, 58 y; age range, 38-79 y) successfully completed the MRA study. MRA studies could not be completed because of failed respiratory gating in three patients and failed ECG gating in two patients. Eighteen of the 27 patients subsequently underwent conventional CAG 3-10 days (mean, 6 days) after the MRA study. NIH Public AccessThere were no clinical events or medication changes recorded between examinations.Patients who had a heart rate of > 70 beats per minute (bpm) at rest received an oral β-blocker (25-50 mg) or IV metoprolol (5 mg) to decrease their heart rate before both the MDCTA and MRA examinations. The difference in heart rate between the MDCTA and MRA studies was < 5 bpm. Sublingual or IV nitroglycerine (5 mg) was used in both coronary MDCTA and MRA to achieve maximal coronary vasodilation in all patients. Coronary MDCTACoronary MDCTA was performed and calcium scores were obtained using a 64-MDCT scanner (Somatom Sensation Cardiac 64, Siemens Medical Solutions). An initial unenhanced ECG-gated scan was obtained for coronary calcium scoring (collimation, 24 × 0.6 mm; pitch, 0.2;...

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“…A combination of the breathhold and free-breathing approaches may improve the success rate of coronary MRA. 23,24 A shortcoming of the volume-targeted approach is the limited coverage of the coronary tree for each acquisition, thus accurate volume planning is required. The mean lengths of LAD and RCA in this study are shorter than that of the studies by Bogaert 25 (72 ± 15 and 90 ± 31 mm, respectively) and Kefer 26 (66 ± 12 and 115 ± 28 mm, respectively).…”

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confidence: 99%

Three-Dimensional Breathhold Magnetization-Prepared TrueFISP

McCarthy¹,

Deshpande²,

Beohar³

et al. 2007

Investigative Radiology

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Purpose-X-ray angiography is currently the standard test for the assessment of coronary artery disease. A substantial minority of patients referred for coronary angiography have no significant coronary artery disease. The purpose of this work was the evaluation of the accuracy of a threedimensional (3D) breathhold coronary magnetic resonance angiography (MRA) technique in detecting hemodynamically significant coronary artery stenoses in a patient population with x-ray angiographic correlation.Materials and Methods-Sequential subjects (n = 33, M/F = 22/11, average age = 57) who were referred for conventional coronary angiography were enrolled in the study. The study protocol was approved by our institutional review board. Each subject gave written informed consent. Volume-targeted 3D breathhold coronary artery scans with ECG-triggered, segmented True Fast Imaging with Steady-state Precession (TrueFISP) were acquired for the left main (LM), left anterior descending (LAD), and right coronary arteries (RCAs). Coronary MRA was evaluated with conventional angiography as the gold standard.Results-The overall sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing any hemodynamically significant coronary artery disease (≥50% diameter reduction) with coronary MRA was 87%, 57%, 72%, 68%, and 80%, respectively. The sensitivity of the technique in the LM, LAD, and RCA was 100%, 83%, and 100%, respectively. The NPV of the technique in the LM, LAD, and RCA was 100%, 82%, and 100%, respectively. Magnetic resonance imaging (MRI) has recently gained wide acceptance in cardiovascular disease examinations. Substantial progress has been made in developing MRI techniques for imaging coronary arteries in the past 10 years. These techniques can be divided into 2 major approaches based on the methods used for reducing respiration-related motion effects: freebreathing techniques with navigator echo-guided slice correction and breathhold techniques. Encouraging results have been shown using the free-breathing approach to detect significant coronary artery disease. [3][4][5] One of the shortcomings of the free-breathing approach is the relatively long imaging time per scan. Suboptimal image quality may result if heartbeat or breathing pattern changes substantially during data acquisition. Conclusions-Three-dimensionalWith the improved gradient system in recent MRI scanners, it is now possible to obtain three-dimensional (3D) images within a single breathhold. 6 However, with the conventional gradient-echo sequence Fast Low Angle Shot (FLASH), the signal-to-noise ratio (SNR) and spatial resolution are limited because of the constraint of the imaging time. 7 Administration of MR contrast media has substantially improved the SNR and contrast-to-noise ratio (CNR) of coronary arteries. [8][9][10][11][12] However, the number of contrast-enhanced breathhold scans in an imaging session was limited by the total contrast volume allowed per subject. Potential errors in time dela...

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Combination of free‐breathing and breathhold steady‐state free precession magnetic resonance angiography for detection of coronary artery stenoses

Cited by 32 publications

References 43 publications

Comparison between the image quality of multisegment and halfscan reconstructions of non-invasive CT coronary angiography

Comparison between the image quality of multisegment and halfscan reconstructions of non-invasive CT coronary angiography

Comparison of 3D Free-Breathing Coronary MR Angiography and 64-MDCT Angiography for Detection of Coronary Stenosis in Patients with High Calcium Scores

Three-Dimensional Breathhold Magnetization-Prepared TrueFISP

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